Recent randomized trials on stage III lung cancer treatment

The optimal strategy for patients with stage III non-small cell lung cancer (NSCLC) is not well-established and significant variation in practice exists across the United States and Europe (1,2). In the U.S., the majority of National Comprehensive Cancer Network (NCCN) member institutions consider surgery to be indicated in stage IIIA patients with involvement of a single N2 lymph node station smaller than 3 cm who have undergone induction chemotherapy (1). However, there is no agreement among institutions regarding treatment for other manifestations of stage IIIA-N2 involvement (e.g., multi-station or bulky disease) and both NCCN and European Society of Medical Oncology (ESMO) guidelines recommend that the role of surgery be discussed in a multidisciplinary tumor board setting (2,3). The lack of consensus regarding treatment strategies for stage III NSCLC is in part due to the paucity of randomized studies available to guide decision-making (4). Recently, though, there have been two randomized controlled trials published that attempt to better elucidate the role of induction therapy regimens and the role of surgery for stage III NSCLC.